Nurse Assisting
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Chapter 17 Expanded Skills

Click on the skills to review expanded skills discussed in this chapter.

Starting-Up Steps

  1. Knock before entering, identify the client, and introduce yourself.
  2. Complete hand hygiene.
  3. Provide for privacy.
  4. Explain to the client what you will be doing before you start doing it.
  5. Assemble your supplies.
  6. Ensure that the bed is at a good working height and is locked; or, if the bed is not in use, you are in an ergonomically correct position to assist the client.

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Applying Splints

When: ​Splints are ordered by the provider or therapist to address a mobility concern. Some splints will remain on throughout the day and be removed at night, while some may be worn at all times only to be taken off during caregiving to check skin integrity and perform range of motion exercises.

Why: ​Splints offer adaptive support to clients who need it.

What: ​Supplies needed for this skill include:

  • Appropriate splint for the client
  • Towel
  • Washcloths
  • Gentle soap as needed

How:

  1. Complete your starting-up steps.
  2. Identify the proper splint the client requires by reviewing the care plan. Ensure it is in good repair. If any defects are noted report that to the nurse and do not use.
  3. Wash the area that will make contact with the splint with water or gentle soap and water. This will be indicated on the care plan. If soap is used completely rinse the area.
  4. Completely dry the area that was washed.
  5. Follow the directives found in the care plan on how to properly apply the splint. You may need to complete range of motion exercises on the affected extremity prior to reapplying the splint. Check the care plan for directives.
  6. Look at the client’s skin that will touch the splint. If there are any red or open areas do not reapply the splint. Report this to the nurse for further assessment.
  7. Apply the splint. Ask the client if the fit feels correct. If not, remove the splint and start over.
  8. Complete your finishing-up steps.

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Removing, Cleaning, and Reinserting an Artificial Eye

When: ​When the client wakes in the morning and before bed in the evening.

Why: ​To maintain a clean prosthetic for the client.

What: ​Supplies needed for this skill include:

  • Towel
  • Suction device, if available
  • Storage cup
  • Normal saline or tap water
  • Contact solution for storage
  • Mild liquid soap
  • Tissues

How:

  1. Complete your starting-up steps.
  2. Cover the overbed table with a towel and place your assembled supplies on it. The towel will prevent breakage if the prosthesis falls.
  3. Rinse the storage cup for the prosthetic eye. Fill it with normal saline or tap water.
  4. Raise the head of the bed to a high-Fowler’s position.
  5. Don gloves.
  6. With your non-dominant hand, place your index finger on the upper eyelid and push upward.
  7. With your dominant hand, squeeze the suction device to expel all air. Place the suction device on the center of the prosthesis, on the pupil. Release the pressure on the suction device to allow for suction on the prosthesis.
  8. With your non-dominant thumb, press down and inward on the lower lid. Remove the prosthesis from the socket.
  9. While removing the prosthesis from the socket, move your non-dominant hand under the prosthesis to protect it from falling and breaking.
  10. If you do not have a suction device, place your dominant hand under the eye. Pull the upper lid up and press the lower lid down and inward with your non-dominant hand.
  11. Next, with your non-dominant thumb, run along the lower lid exerting inward and downward pressure until the prosthesis comes out. You may need to remove the prosthesis with your dominant hand if it does not come out on its own.
  12. Hand the client a tissue for any tearing or drainage. Assist the client if they are unable.
  13. Place the prosthesis in the storage cup.
  14. Remove gloves, and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
  15. Lower the head of the bed and the bed itself before walking away from the client.
  16. Don gloves.
  17. Take the prosthesis to the bathroom sink.
  18. Place a towel in the bathroom sink to protect the prosthesis from breaking if it falls. Turn on warm water, and keep it running.
  19. Slightly dampen a tissue, and apply a small amount of soap to it.
  20. Rub the prosthesis with the soapy tissue to remove any film or debris. Rinse off all soap with warm water running from the tap.
  21. If the prosthesis is to be replaced immediately:
    1. Hold the prosthesis in your dominant hand, and empty and refill the storage cup with normal saline or tap water with your non-dominant hand.
    2. Place the cleaned prosthesis in the storage cup.
    3. Return the prosthesis to the client.
  22. If the prosthesis is not to be replaced immediately:
    1. Hold the prosthesis in your dominant hand, and empty and refill the storage cup with contact solution with your non-dominant hand.
    2. Completely submerge the prosthesis in the contact solution. Place an airtight cover on the cup.
    3. Place the prosthesis either in the designated storage area in the client’s room or with the nurse.
  23. If the client needs assistance replacing the prosthesis:
    1. Return the bed to a good working height and raise the head of the bed to a high-Fowler’s position.
    2. Hold the prosthesis in your dominant hand, between your thumb and index finger.
    3. If using a suction device, squeeze the device to expel all air, place the prosthesis on it, and release the pressure on the suction device to allow for suction on the prosthesis.
  24. With your non-dominant index finger, push the top eyelid upward and work the prosthesis into the socket along the upper lid margin.
  25. With your non-dominant thumb, pull the eyelid downward, working the prosthesis into the socket along the lower lid margin. If using the suction device, remove it at this time.
  26. Assist the client in moving the prosthesis around until it is appropriately and comfortably positioned in the socket.
  27. Remove gloves, and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
  28. Lower the head of the bed and the bed itself before walking away from the client.
  29. Don gloves.
  30. Place the soiled towel in the linen bag.
  31. Return to the bathroom and squeeze excess water from the towel in the sink. Place the towel in the linen bag.
  32. If a suction device was used, clean it with tap water or normal saline and return it to the designated storage area.
  33. Remove gloves, and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
  34. Complete your finishing-up steps.

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Care for an Artificial Limb

When: ​When the client wakes in the morning and before bed in the evening.

Why: ​To maintain a clean prosthetic for the client.

What: ​Supplies needed for this skill include:

  • Any supportive items such as shrink socks
  • Towel
  • Wash cloths
  • Gentle soap as needed

How:

  1. Complete your starting up steps.
  2. Identify the proper prosthesis the client requires by reviewing the care plan. Ensure it is in good repair. If any defects are noted report that to the nurse and do not use.
  3. Wash the area that will make contact with the device with water or gentle soap and water. This will be indicated on the care plan. If soap is used completely rinse the area.
  4. Completely dry the area that was washed.
  5. Follow the directives found in the care plan on how to properly use the prosthetic device and any supportive materials such as shrink socks. Ensure there are no wrinkles in any supportive materials prior to placing the prosthesis.
  6. Look at the client’s skin that will touch the prosthesis. If there are any red or open areas do not reapply the prosthesis. Report this to the nurse for further assessment.
  7. Apply the prosthesis. Ask the client if the fit feels correct. If not, remove the prosthesis and start over.
  8. Complete your finishing up steps.

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Applying Postural Supports

When: When ordered by a physician or therapist and only when required to support the client’s postural needs.

Why: To help a client maintain proper posture and support.

What: Supplies needed for this skill include

  • A postural support device

How:

  1. Complete your starting-up steps.
  2. Identify which postural supports or safety devices the client requires based off of the care plan directives.
  3. For any postural supports or safety devices you are not familiar with ask for clearer directives from the nurse prior to applying.
  4. Apply the postural supports or safety devices as per the care plan and/or nurse directives.
  5. Ensure the client is safe and comfortable.
  6. Complete your finishing-up steps.

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Using Rehabilitative Devices

When​: ​Use a rehabilitative device during ADLs as outlined in the care plan.

Why: ​To support the client’s rehabilitative processes and to maximize client independence and potential.

What: ​Supplies needed for this skill include:

  • Appropriate rehabilitative device(s)

How:

  1. Complete your starting-up steps.
  2. Check the client’s care plan to determine which rehabilitative devices are required during assistance with ADLs.
  3. Ensure the rehabilitative devices are in working order and pose no safety risk to the client. Report if the devices are not working properly and do not use.
  4. Ensure the devices are appropriately sized for the client. If you are unsure or if it is not sized correctly ask for assistance from the nurse or from the therapy department staff.
  5. Complete your caregiving using the appropriate devices.
  6. Complete your finishing-up steps.

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Finishing-Up Steps

  1. Ensure that all of the client’s needs have been met and that the client is positioned as desired.
  2. See to safety. Replace any alarms or positioning devices, as indicated on the care plan or individual service plan. The bed is in the low position and is locked.
  3. Place the call light within easy reach.
  4. Clean and replace equipment, and return supplies to the designated place in the client’s room or facility storage area.
  5. Leave the room clean and in order. Ensure that the bed is made. Remove trash and dirty linens from the room.
  6. Complete hand hygiene.
  7. Report and document, as required by your facility.

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